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See a sample rate comparisonCPT 25443 Fee Schedule
CPT 25443 is classified under Surgery, in the Surgical Procedures on the Musculoskeletal System subgroup.
Arthroplst W/ Prosthet Replac; Scaphoid Carpal (Navicular), Arthroplasty With Prosthetic Replacement; Scaphoid Carpal (Navicular)
| Key Fact | Detail |
|---|---|
| Service Type | Surgery Surgical Procedures on the Musculoskeletal System |
| Common Place of Service | 24Ambulatory Surgical Center 22On Campus Outpatient Hospital |
| Common Modifiers | RTRight side of body LTLeft side of body |
| Hospital Outpatient Group (APC) | APC 5114 - Level 4 Musculoskeletal Procedures |
| Surgery Center Payment (ASC) | J8 - Device-intensive procedure, paid at an adjusted rate |
| Common Revenue Codes | 0360 |
| Medicare Fee Schedule | View Medicare rates for 25443 |
| Medicaid Fee Schedule | $587.98 median of the 8 states in the free previewView Medicaid rates for 25443 |
National average reimbursement for CPT 25443 by major payers:
$1,136.34
BCBS / Anthem
$1,054.48
UnitedHealthcare
$1,068.06
Aetna
$1,287.20
Cigna
Compare published rates across providers.
Choose a payer to see a sample of rates for CPT 25443.
CPT 25443
5 of 25 sample ratesHigher to lower in this preview
Lehigh Valley Hospital Muhlenberg
Lehigh Valley Hospital
$23,947.86Published rateTucson Digestive Institute LLC, Arizona Digestive Institute
$5,020.00Published rateSeattle Pain Relief PLLC, Federal Way Ambulatory Surgical Facility
Seattle Pain Relief PLLC
$3,200.00Published rateTallgrass Surgical Center, LLC
$2,200.00Published rateMelbourne Asc Lp, The Surgery Center Of Melbourne
Melbourne Asc Lp
$410.00Published rate
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Payer Contract Negotiation
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See a sample payer proposalCPT 25443 vs. Other Surgical Procedures on the Musculoskeletal System Codes
The table lists codes related to 25443. Select one to see its fee schedule.
| Code | Description |
|---|---|
| 25443-CPT | Arthroplst W/ Prosthet Replac; Scaphoid Carpal (Navicular), Arthroplasty With Prosthetic Replacement; Scaphoid Carpal (Navicular) |
| 25444-CPT | Wrist Joint Replacement, Surgery To Replace Worn Out Ends Of Wrist Joint With An Artificial Part (Prosthesis). |
| 25445-CPT | Arthropl.W/Prosth Replac;Trapezium |
| 25446-CPT | Arthroplst W/ Prosthet Replac; Distal Radius & Partial Or, Arthroplasty With Prosthetic Replacement; Distal Radius And Partial Or |
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including CPT 25443. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the 25443 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
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Frequently Asked Questions
What APC is CPT 25443 assigned to?
Medicare's hospital outpatient payment system (OPPS) assigns CPT 25443 to APC 5114 (Level 4 Musculoskeletal Procedures). An APC groups outpatient services that Medicare pays at the same base rate.
How does Medicare pay for CPT 25443 in an ambulatory surgery center?
CMS lists CPT 25443 with ASC payment indicator J8: Device-intensive procedure, paid at an adjusted rate.
Which revenue codes are billed with CPT 25443?
Hospital price transparency files list CPT 25443 under these revenue codes: 0360. A revenue code names the hospital department or charge category for the line; it does not change what the service is.